From: Management of sexual dysfunction in breast cancer survivors: a systematic review
Systemic Therapy Interventions | ||||||
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Reference | Outcomes | Intervention results | Control results | Comparisons | Quality of evidence (GRADE) | Comments |
Barton (2007) [34] | All measures normalized to 100 point scale: | Mean change (95 % CI): | Mean change (95 % CI): | 1. p = 0.58 | Moderate | • Dropout: 12 % |
1. 5.5 (2.2-8.8) | 1. 4.4 (2.4-6.5) | 2. p = 0.11 | • Side effects and quality of life did not differ by group. | |||
1. Sexual desire (CSFQ desire subscale) | 2. 9.4 (7.0-11.2) | 2. 4.7 (0.4-9.0) | 3. p = 0.14 | |||
2. Pleasure (CSFQ pleasure subscale) | 3. 5.7 (4.1-10.6) | 3. 3.4 (2.1-6.8) | 4. p < 0.001 for both measures | |||
3. Sexual function (CSFQ total score) | 4. Total 92.8 (74.9-110.7) | 4. Total 1.2 (-1.8-4.3) | 5. p = 0.82 | |||
4. Serum testosterone, ng/dL | Free 1.6 | Free 0.18 (-0.1-0.5) | 6. p = 0.11 | |||
5. Serum estradiol, pg/mL | (1.2-2.0) | 5. 0.5 (-5.2-6.1) | 7. p = 0.93 | |||
6. Serum SHBG, nmol/L | 5. -0.3 (-2.9-2.4) | 6. -0.3 (-3.0-2.3) | ||||
7. Serum AST, U/L | 6. -3.1 (-5.1- -1.0) | 7. 0.2 (-1.1-1.5) | ||||
7. -0.23 (-1.3-0.8) | ||||||
Buijs (2009) [42] | 1. Sexual function (Sexual Activity Questionnaire) | 1. Venlafaxine: No change | 1. No control | 1. Not reported | Moderate | • Dropout: 33 % |
Clonidine: No change | ||||||
Nunez (2013) [41] | 1. Sexual function (Arizona Sexual Experience Scale) | Pre- to post- difference (SD): | Pre- to post- difference (SD): | 1. p = 0.5 | Moderate | • Dropout: 11 % |
1. 1.4 (3.8) | 1. 0.6 (3.4) | |||||
Physical activity interventions | ||||||
Berglund (1994) [45] | 1. Sexual problems frequency (Scale 0-4) | Pre, post, 3-month mean scores (SD): | Pre, post, 3-month mean scores (SD): | 1. Not significant | High | • Dropout: 8 % |
1. 0.7 (1.2), 0.6 (1.0), 0.5 (1.0) | 1. 0.6 (1.0), 0.5 (0.9), 0.4 (0.7) | |||||
Duijts (2012) [43] | 1. Sexual function (Sexual Activity Questionnaire, habit subscale) | Baseline, 12-week mean scores (SD): | Baseline, 12-week mean scores (SD): | Effect size (intervention to waitlist control at 12 weeks): | Moderate | • Dropout: 17 % |
• Significant under-compliance: | ||||||
1. CBT: 0.3 (0.8), 0.5 (0.8) | 1. 0.6 (0.8), 0.6 (0.8) | 1. CBT: 0.31, p = 0.13 | ||||
PE: 0.6 (0.8), 0.6 (0.8) | PE: 0.01, | 58Â % CBT; 64Â % PE; | ||||
CBT/PE: 0.4 (0.8), 0.5 (0.8) | p = 0.97 | 70 % CBT/PE | ||||
CBT/PE: 0.15, | ||||||
p = 0.44 | ||||||
Speck (2010) [44] | 1. Self-perception of appearance and sexuality (Body Image Relationships Scale appearance and sexuality subscale) | Mean % change (SD): | Mean % change (SD): | 1. p = 0.004 | Moderate | • Dropout: 21 % |
1. 7.3 (16.6) | 1. -0.7 (18.1) | |||||
Individual-based counseling and educational interventions | ||||||
Allen (2002) [55] | 1. Sexual health (CARES sexual subscale) | Baseline, 4-month mean scores (SD): | Baseline, 4-month mean scores (SD): | 1. p > 0.05 | High | • Dropout: 9 % |
2. p > 0.05 | ||||||
2. Marital relationship (CARES marital subscale) | 1. 2.2 (1.1), 2.1 (0.9) | 1. 2.0 (1.0), 2.0 (0.9) | ||||
2. 1.8 (0.8), 1.7 (0.7) | 2. 1.6 (0.7), 1.5 (0.6) | |||||
Anderson (2015) [46] | 1. Sexual function (sexual function subscale, Greene Climacteric Scale) | Baseline, 12-week mean score (SD) and effect size Cohen’s d: | Baseline, 12-week mean score (SD) and effect size Cohen’s d: | 1. p = 0.05; | Moderate | • Dropout: 9 % |
Cohen’s d 2 of post-intervention scores = 0.10 | ||||||
1. 2.0 (1.0), 1.3 (1.0) | 3. 1.6 (1.1), 1.4 (1.0) | |||||
d = 0.65 | d = 0.18 | |||||
Ganz (2000) [48] | 1. Menopausal Symptom Scale Score (hot flash, vaginal and urinary subscales of BCPT Symptom Checklist) | Mean change score (95 % CI): | Mean change | 1. p < 0.01 | Moderate | • Dropout: 5 % |
1. 0.57 | score (95 % CI): | 2. p = 0.03 | • Both groups used educational materials. | |||
(0.40-0.74) | 1. 0.09 | |||||
2. Sexual health (sexual summary subscale of CARES) | 2. 0.46 | (−0.04-0.21) | • Intervention group more likely to receive pharmaco-logic and behavioral interventions. | |||
(0.30-0.62) | 2. 0.11 | |||||
(−0.16-0.38) | ||||||
Germino (2013) [56] | 1. Sexual function (Medical Outcomes Study – Sexual Functioning) | Mean score (SD) at baseline, 4-6 months, 8-10 months: | Mean score (SD) at baseline, 4-6 months, 8-10 months: | 1. p = 0.03 at 4-6 months follow up | Moderate | • Dropout: None |
• Single time point statistically different without adjustment for baseline differences. | ||||||
1. 2.1 (1.0), 2.0 (1.0), 2.0 (1.1) | 1. 2.3 (1.1), 2.3 (1.1), 2.2 (1.1) | |||||
Greer (1992) | 1. Sexual relationships (subscale of Psychological Adjustment to Illness Scale) | Mean difference (SD) from baseline to 8-weeks, to 4-months: | Mean difference (SD) from baseline to 8-weeks, to 4- months: | 1. p = 0.53 at 8-week, p = 0.47 at 4-months | Moderate | • Dropout: 21 % |
1. 0.7 (7.2), -1.3 (7.7) | 1. -0.4 (8.1), -1.4 (8.2) | |||||
Jun (2011) [49] | 1. Marital intimacy (Martial Intimacy Questionnaire) | Change in mean (SD) scores: | Change in mean (SD) scores: | 1. p = 0.29 | Low | • Dropout: 25 % |
1. +2.0 (5.0) | 1. +0.6 (2.1) | 2. p = 0.45 | ||||
2. Sexual interest (subscale, CARES) | 2. -0.2 (0.6) | 2. -0.1 (0.9) | 3. p = 0.53 | |||
3. Sexual dysfunction (subscale, CARES) | 3. -0.1 (1.0) | 3. +0.1 (1.1) | 4. p < 0.001 | |||
4. Sexual satisfaction (Sexual Satisfaction Scale) | 4. +5.3 (9.0) | 4. -3.4 (5.8) | ||||
Marcus (2010) [57] | 1. Sexual function, (behavioral, evaluative and body image subscales of Sexual Dysfunction Scale) | Baseline, 12- and 18-month mean scores (approximated from figure): | Baseline, 12- and 18-month mean scores (approximated from graph): | Comparison by intervention group: | Moderate | • Dropout: 20 % |
1. 47, 40, 40 | 1. 45, 43, 43 | 1. p = 0.03 at 12-month, | ||||
p = 0.04 at 18-month | ||||||
Rowland (2009) [51] | Likert scales: | Mean change in score (SD): | Mean change in score (SD): | Per-protocol comparisons: | Low to very low | • Dropout: 56 % |
1. Satisfaction with variety of sexual activities | 1. 0.1 (1.2) | 1. -0.03 (1.0) | 1. p = 0.23 | • Intervention group: 89/284 (29 %) agreed to participate; 72/284 (25 %) attended ≥ 1 session. | ||
2. 0 (1.5) | 2. -0.3 (1.0) | 2. p = 0.02 | ||||
2. Relationship satisfaction | 3. 0.7 (1.5) | 3. -0.1 (1.7) | 3. p = 0.09 | |||
3. Dyspareunia | 4. 0.3 (1.4) | 4. 0 (1.1) | 4. p = 0.29 | |||
4. Pain interferes with pleasure | 5. Not reported | 5. Not reported | 5. p = 0.03 | |||
5. Improved comfort with sexuality | ||||||
Salonen (2009) [58] | 1. Sexual functioning (subscale 0-100, EORTC QLQ-BR23) | Mean score (SD): | Mean score (SD): | 1. p = 0.2 | High | • Dropout: 9 % |
1. 29 (26) | 1. 24 (22) | |||||
Schover (2006) [52] | 1. Sexual Dysfunction (FSFI) | 1. Not reported | 1. Not reported | 1. No difference | Very low | • Dropout: 20 % |
Schover (2011) [53] | 1. Sexual Dysfunction (FSFI) | 1. Not reported | 1. Not reported | 1. No difference | Very low | • Dropout: 38 % |
Vos (2004) [60] | 1. Sexual function (subscale, QLQ-BR32) | 1. Not reported | 1. Not reported | 1. Regression coefficient comparing intervention to control: -0.17 (p > 0.05) | Low | • Dropout: 21 % |
Couple-based counseling and educational interventions | ||||||
Baucom (2009) [47] | 1. Marriage quality (Quality of Marriage Index) | Baseline, 12-week, 12-month mean score (SD): | Baseline, 12-week, 12-month mean score (SD): | Effect size of treatment to controls: | Low | • Dropout: 14 % |
2. Sexual function (Derogatis Inventory of Sexual Functioning) | 1. Female: 34.0 (13.6), 39.3 (4.7), 39.7 (3.5) | 1. Female: 40.8 (6.0), 42.2 (4.1), 40.2 (5.1) | Baseline to 12-weeks | |||
Male: 39.3 (6.6), 39.6 (5.9), 39.6 (5.2) | Male: 42.5 (3.0), 37.5 (13.6), 41.0 (6.2) | 1. Female 0.48 | ||||
Male 0.64 | ||||||
2. Female: 11.5 (5.0), 12.7 (4.1), 13.0 (3.1) | 2. Female: 10.3 (4.8), 9.8 (5.8), 9.8 (5.9) | 2. Female 0.34 | ||||
Male 0.38 | ||||||
Male: 12.4 (1.5), 13.9 (2.8), 13.2 (2.4) | Male: 12.0 (3.9), 12.3 (2.8), 9.4 (4.5) | Baseline to 12-months | ||||
1. Female 0.77 | ||||||
Male 0.34 | ||||||
2. Female 0.42 | ||||||
Male 1.04 | ||||||
Christensen (1983) [61] | 1. Sexual satisfaction (Sexual Satisfaction Scale) | Post-test mean score (SD): | Post-test mean score (SD): | 1. p < 0.05 for both partners | High | • Dropout: None |
1. Female partner: 80.4 (31.5) | 1. Female partner: 69.0 (20.2) | |||||
Male partner: 81.3 (28.7) | Male partner: 67.3 (28.6) | |||||
Kalaitzi (2007) [50] | 1. Sexual desire frequency | Baseline, 12-week mean scores (95 % CI): | Baseline, 12-week mean scores (95 % CI): | 1. p = 0.73 |  | • Dropout: None |
2. Intercourse frequency | 2. p = 0.14 | |||||
3. Masturbation frequency | 1. 2.9 (2.3-3.4), 2.8 (2.3-3.2) | 1. 3.0 (2.6-3.4), 2.7 (2.2-3.1) | 3. p = 0.32 | |||
4. Orgasm frequency | 2. 3.2 (2.7-3.6), 2.9 (2.5-3.3) | 2. 3.2 (3.0-3.4), 2.5 (2.1-2.9) | 4. p = 0.03 | |||
5. Initiative for sex | 3. 1.9 (1.4-2.3), 1.6 (1.2-2.0) | 3. 1.9 (1.6-2.2), 1.9 (1.5-2.2) | 5. p < 0.001 | |||
6. Satisfaction with relationship | 4. 3.3 (2.8-3.8), 3.7 (3.4-4.0) | 4. 3.6 (3.1-4.0), 3.1 (2.6-3.6) | 6. p = 0.01 | |||
5. 2.2 (1.8-2.6), 2.7 (2.3-3.0) | 5. 2.6 (2.2-3.0), 1.8 (1.4-2.2) | |||||
6. 3.8 (3.3-4.2), 4.5 (4.2-4.7) | 6. 3.3 (2.9-3.7), 3.7 (3.2-4.1) | |||||
Schover (2013) [54] | 1. Sexual function (FSFI) | Linear mixed model coefficients, post-treatment versus baseline: | Linear mixed model coefficients, post-treatment versus baseline: | 1. p = 0.024 | Low | • Dropout: 36 % |
2. Sexual satisfaction (Menopausal Sexual Interest Questionnaire) | 2. p = 0.01 | |||||
1. 7.4 | 1. 2.8 | |||||
2. 13.2 | 2. 3.4 | |||||
Scott (2004) [96] | 1. Sexual Self Schema Scale | Baseline, post-treatment mean score(SD): | Baseline, post-treatment mean score (SD): | Effect size, p-value of couples coping vs other two conditions: | Moderate | • Dropout: 11 % |
2. Sexual desire (subscale, Brief Index of Sexual Function) | Couples coping | Medical information | 1. d = 0.8, p < 0.05 | |||
3. Sexual arousal (subscale, Brief Index of Sexual Function) | 1. 57.3 (13.5), 62.8 (12.2) | 1. 55.4 (14.3), 55.8 (11.0) | 2. No difference | |||
2. 4.2 (2.8), 4.0 (2.3) | 2. 3.1 (1.9), 2.4 (2.4) | 3. No difference | ||||
3. 2.7 (2.5), 2.0 (2.0) | 3. 1.9 (1.4), 1.6 (1.6) | |||||
Patient coping | ||||||
1. 55.7 (14.3), 56.0 (12.0) | ||||||
2. 3.7 (2.6), 2.7 (2.9) | ||||||
3. 3.1 (1.6), 2.2 (2.3) |